Background to the study
Pregnancy and childbirth are normal physiological processes that bring joyful experiences to individuals and families. However, in many parts of the world, pregnancy constitutes a perilous journey, a risky and potentially fatal experience for millions of women especially in developing countries. Over 289,000 women die annually from complications during pregnancy, childbirth, or postpartum period (World Fact book, 2014 andWHO,UNICEF,UNFPA &The World Bank 2014). About 70% of these deaths are largely treatable or at least preventable (UNICEF, 2010) and nearly all these deaths (over 90%) occur in developingcountries where fertility rates are higher and a woman’s life time risk of dying during pregnancy and childbirth is over 400 times higher than in developed countries (Audu, Takai, &Bukar, 2010).
The situation in Nigeria is especially grave as maternal mortality rateas high as630 per 100,000 live births is still recorded (World Health Organization, UNICEF & The World Bank, 2014), thus including Nigeria among the nations with the highest number of maternal deaths (WHO, 2010, National Primary Healthcare Development Agency (NPHCDA) 2009). Nigeria makes up only 1% of the total world population but accounts for about 10% of the global estimate for maternal mortality (FMOH & NPHCDA, 2010). The new-born and under-five mortality rates follow the same trend with an estimated infant mortality rate of 74/1,000 (Index Mundi, 2014).This ugly trend has been traced to deliveries being attended to by unskilled birth attendants (N&MCN Newsletter 2011 & NPHCDA, 2009).
It is against this backdrop that the Midwives Service Scheme [MSS] was initiated in 2003 by the Nursing and Midwifery Council of Nigeria (N&MCN) though originally as a mandatory service for newly qualified basic midwives (NMCN Newsletter, 2011). Subsequently, the NPHCDA in collaboration with the Nursing and Midwifery Council of Nigeria (N&MCN) and the FMOH in 2009 expanded the programme to include retired but active midwives, unemployed midwives and fresh graduates of basic midwifery as a rescue initiative to provide an emergency stopgap to the human resource shortage of skilled birth attendants at the level of primary health care (PHC) (Nigerian Health Watch, 2011 and N&MCN Newsletter, 2011).
The choice of MSS as a remedy for maternal, new-born and under-five mortality was informed by the successes recorded by Egypt through the same means. Egypt witnessed a dramatic reduction in maternal mortality ratio from 174 per 100,000 live births in 1990s to 84 per 100,000 live births in 2000 and further reduction to 68 per 100,000 in 2003 (UNICEF, 2010). In Sierra Leone, the high mortality rates in under-fives of 296 per 1000 live births for boys and 269 per 1000 live births for girls in 2004 was attributed to lack of skilled birth attendants among other factors (Oluwale,2004). In like manner, the outrageous rates of maternal mortality of 2000 per 100,000 live births in Sierra Leone has also been attributed to the lack of skilled birth attendants. Consequently, the United Nations have chosen to use the percentage of deliveries assisted by skilled birth attendants as the most important measure of progress towards reducing maternal mortality because of the high correlation between access to skilled care and better maternal outcome.
The establishment of MSS is a bold and commendable stance on the part of Nigeria. The MSS has been locally and internationally perceived as a worthwhile intervention programme. For instance, the former executive director of NPHCDA Mohammed Ali Pate perceived the scheme as an important measure towards achieving better maternal and new born health and strengthening the primary health care system in Nigeria (NPHCDA, 2009). On the global platform, the MSS has also received positive perception consequent upon which it was nominated for 2012 international award by the Commonwealth Association for Public Health Administration and Management (CAPAM). (N&MCN 2012). However, the success depends on how the midwives and mothers – (the key players in the scheme) perceive the scheme. There is therefore need to ascertain their views with respect to their new role of being solely in charge and responsible for maternal and child health in the MSS facilities contrary to the conventional hospital setting. Their perception regarding this scheme will significantly reflect the success or failure of the scheme since they are key players in the scheme. In the light of the above, there is a need to find out how they perceive the scheme.
Statement of problem
Deliveries by skilled birth attendants (SBAs) serve as indicators of progress toward reducing maternal mortality worldwide – (MDG 5). Based on this, midwives were posted to primary health care facilities in Nigeria under the midwives service scheme to ensure that pregnant women are attended to by skilled health care providers. The various communities were duly informed of the presence of the skilled health care providers at the PHC facilities and the need for them to access care from them. The expectation is that the mothers will comply by using the services of the midwives.
However, evidence at the health care facilities show poor patronage of the services of these skilled healthcare providers – MSS midwives.For instance, the total deliveries in Gwako PHC facility inGwagwalada Area Council in 2012 was 54 and that of Kuchibuyi in Bwari Area Council was 23, (i.e, the monthly average of approximately 5 and 2 respectively).In addition to the above, Nigerian Health Watch (2011) reported that mothers still patronize the traditional birth attendants (TBAs) even with the presence of the midwives in their midst. The implication is that the women are not getting the care they need and therefore maternal mortality will continue to increase. Having once been part of the MSS, the researcher also observed that some of the midwives that were posted to the primary health care facilities were not always there when they were expected to be. The researcher wondered how these key players in MSS (providers and consumers) perceive the scheme and therefore was motivated to undertake the study.
Purpose of Study
The purpose of the study was to find out how mothers and midwives in selected Area Councils in Abuja perceive the midwives service scheme. Based on this purpose, the following specific objectives were set:
The specific objectives to the study are to:
- Assess midwives’ perception of the implementation of the MSS
- Determine the midwives’ view of their role in the MSS.
- Ascertain the midwives perception of their remuneration in the MSS.
- Ascertain the mothers’ perception of the services of the midwives in the MSS.
- Determine if there is an association between the mothers’ demographics and their perceived reasons for the MSS.
- To determine the factors perceived by midwives as negatively influencing provision of services MSS.
The following null hypotheses to be tested at 0.05 level of significance were established to guide the study.
H01 The mothers’ parity will not significantlyinfluence their perception of the MSS.
H02 There will be no significant difference in the midwives’ qualification and their perception of theMSS.
H03 There will be no significant difference in the midwives’ years of service in the MSS and their perception of the scheme.
Significance of Study
It is expected that findings of the study will help to ascertain the perception of mothers and midwives about MSS. Since the midwives are the principal actors in the scheme and the mothers are the users of the services provided, the opinion of these two groups of people will go a long way in buttressing the strengths and weaknesses of the programme (in terms of its formation and operation) and factors enhancing and/or militating against its efficacy. These findings therefore will serve as useful guide for policy makers in decisions toward improving or making progressive changes or adjustments in the programme if necessary. The findings from the study will also add to the existing body of knowledge as well as serve as a useful reference for other researchers who will be carrying out studies in related areas. These findings will also be of importance to the Federal Government of Nigeria in achieving the Millennium Development Goals 4&5. Other Non-Governmental Organizations or agencies that have interest in women’s health will also make use of these findings.
Scope of Study
This study was delimited to only midwives recruited into MSS who are working in MSS PHC facilities in Bwari and Gwagwalada Area Councils as well as mothers of child bearing age pregnant at the time of the study and/or those who have had at least one previous pregnancy and childbirth since the inception of the scheme in the communities where the midwives are working. The study was also delimited to eliciting midwives view on the implementation of the MSS, their role in the scheme and the remuneration of midwives in the scheme. It was also delimited to eliciting mothers’ views of the services provided by the midwives and if there is an association between the mothers’ demographics and their perceived reasons for MSS.
Operational definition of terms
Perception of the midwives service scheme: the midwives’ opinion about the implementation of the scheme, their role in the scheme, and the remuneration of midwives in the scheme. Perception of role in the midwives service scheme: what the midwives view as their functions in the PHC facility and whether the stipulated work in MSS is appropriate or too much for them.
Perception of remuneration in midwives service scheme: this is the view of the midwives about their salaries in MSS.
Perception of mothers for midwives service scheme: this implies the view of the mothers regarding the ability of midwives in taking care of mothers during pregnancy and child birth.